Predicting patterns of service utilization within children’s mental health agencies

Abstract

BackgroundSome children with mental health (MH) problems have been found to receive ongoing care, either continuously or episodically. We sought to replicate patterns of MH service use over extended time periods, and test predictors of these patterns.MethodsLatent class analyses were applied to 4 years of visit data from five MH agencies and nearly 6000 children, 4- to 13-years-old at their first visit.ResultsFive patterns of service use were identified, replicating previous findings. Overall, 14% of cases had two or more episodes of care and 23% were involved for more than 2 years. Most children (53%) were seen for just a few visits within a few months. Two patterns represented cases with two or more episodes of care spanning multiple years. In the two remaining patterns, children tended to have just one episode of care, but the number of sessions and length of involvement varied. Using discriminant function analyses, we were able to predict with just over 50% accuracy children’s pattern of service use. Severe externalizing behaviors, high impairment, and high family burden predicted service use patterns with long durations of involvement and frequent visits.ConclusionsOptimal treatment approaches for children seen for repeated episodes of care or for care lasting multiple years need to be developed. Children with the highest level of need (severe pathology, impairment, and burden) are probably best served by providing high intensity services at the start of care.

Referral patterns to outpatient child and adolescent mental health services and factors associated with referrals being rejected. A cross-sectional observational study

“…More than a third of referrals to CAMHS were re-referrals. This is comparable to previous findings from the UK [ 20 ] and Canada [ 38 , 39 ]. Despite high re-referral rates, there is a paucity of research on predicters of re-referral to outpatient CAMHS [ 40 ].…”

“…There is a need for more research on predictors of re-referral to outpatient CAMHS to identify targets for improvement of service provision for CYP with mental disorders. Regardless of the explanation, the high referral rates call for research on how to optimize services for children with a repeated need for referral to CAMHS [ 39 ]. With the knowledge of high comorbidity rates, it is positive that we found that previously having been assessed for a psychiatric diagnosis is associated with a decreased risk for a referral being rejected.…”

Association between single session service attendance and clinical characteristics in administrative data

“…Peer relationship problems, as well as low frequency problems, such as substance abuse, sometimes coexist with complexity factors such as learning difficulties and family relationship difficulties (Cantwell & Baker, 1991;Denton & Kampfe, 1994) further identifying additional barriers to accessing care. Previous research has demonstrated that young people with fewer difficulties and contextual issues specific to impact on the family burden, child impairment and externalising difficulties were more likely to require minimal input (Reid et al, 2019). This raises further questions about service utility and barriers to care.…”

“…Further, with the high proportion of young people previously demonstrated as attending for a single session only (Wolpert et al, 2015), it is important to understand the specific needs of this group. This is particularly important in light of the prior research which highlights differential access to services amongst families (Pandiani et al, 2005;Reardon et al, 2017;Sadler et al, 2017;Stein et al, 2003) and differences between single session attenders both between and within services (Martin et al, 2017;Reid et al, 2019). Given the paucity of research in this specific area, the present research is key to contribute towards beginning to understand who these young people are, which in turn will allow further consideration to be given to how to best support them and their families, and the associated resource allocation in models such as THRIVE.…”

“…To date, the long-term commitment of young people and families is considered to be a key element in successful interventions, with an emphasis on a failure to treat if non-attendance occurs after one session (Campbell, 1999). Research has however demonstrated that single session attenders do not necessarily have poorer outcomes than those who attend for more than one session (Bloom, 2001;Reid et al, 2019;Talmon, 1990). Further, with the high proportion of young people previously demonstrated as attending for a single session only (Wolpert et al, 2015), it is important to understand the specific needs of this group.…”